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Neulasta (pegfilgrastim)

Donnagulu
Posts: 1
Joined: Sep 2010

I completed 3 cycles of RCHOP - at the finish of the first tx I was given an injection of 6 mg of Neulasta as a preventative to nertropenia. My side effects were horrible - lots of bone pain, joint and body aches, head ache, jaw pain, gum pain, teeth pain ear aches etc. The next two cycles we cut the dose to 3 mg to see if it would take care of it. The pharmacist also suggested trying claritin to reduce side effects. Although not as bad as on the higher dose the constant pain and tiredness is putting be into a real funk. My WBCs and neutrophils are fine. I am going to talk to my doctor about skipping the neulasta. I am off work during this time and feel I can protect myself from infection. Are others doing RCHOP without using neulasta or neupogyn? It seems I have read a number of posts where folks don't start it until there is a problem - not before.

vinny59's picture
vinny59
Posts: 1030
Joined: Nov 2006

Hi, if your white count's are fine, I can't see why they would be giving you the shot's, I have to get three of those nasty shot's because my white count's are below 1. I would talk to your Onc...... Vinny

tcvine's picture
tcvine
Posts: 174
Joined: Aug 2010

Hi All,
Just from my very brief experience, I have received the neulasta shot after both of my first 2 infusions. I have been very fortunate that I have not had any significant side effects. My onc gives the shot to help stave off the fall of white blood cell count. He apparently believes that it is better to keep it from happening than to treat it after it happens. And, since I don't have any problems with it to date, I am good with that. But if I were in your spot with bad reactions, it would be different.

Hope it gets better soon,
Much comfort,
Tom

COBRA666's picture
COBRA666
Posts: 2418
Joined: May 2010

TOM,
I get the neulasta shot after each treatment as well. My wbc's were always in the high range before treatment started and dropped some after I started treatment, but high for a person in treatment. The shot was to maintain the levels of wbc's during treatment. Its a good thing too. I developed a tooth impaction after the 5th round. If not for those shots I would have been in a world of crap. That infection would, NOT could, but would have dropped my wbc's to a real low level. I never had any reaction to the shot that I know of anyway. Now if I would have had some sort of reaction I may feel differently,maybe. John

allmost60's picture
allmost60
Posts: 3163
Joined: Jul 2010

My first blood work was done on June 24th.
My first round of chemo was done on August 31st.

(Range of reference for WBC's = 4.0-11.0)
(Range of reference for RBC's = 3.50-5.50)

These are my counts starting from June 24th through Sept 7th.
June 24th...WBC was 6.2...RBC was 5.04
July 13th...WBC was 5.9...RBC was 5.04
Aug 16th....WBC was 5.9...RBC was 4.83
Aug 31(1st chemo)...
WBC was 12.8H...RBC was 4.72
Sept 7th (one week after 1st chemo)...
WBC was 7.4 K/UL...RBC was 4.68 M/UL

Just curious.. for those of you who keep track of your blood counts..( John, Vinny, Beth, Mary & others) and understand what to look for...could you look at my counts and tell me if all looks good? I had blood work done on last Friday the 17th, but won't see those results until Tuesday morning when I see my onc right before getting round 2 chemo. I feel great, but was told my counts could be low and even if I have plenty of energy, that is not always an indicator that all is well.I understand if you don't feel like bothering with this...it's really no big deal as I will know more on Tuesday. I'm just getting the pre-treatment jitters I guess...Thanks...Sue

COBRA666's picture
COBRA666
Posts: 2418
Joined: May 2010

Sue,
I will do the best I can. You are 100% correct with the normal counts. I am looking at my sheets. My first blood work my wbc was 8.4 and rbc was 8.1. After 1st treatment wbc was down to 6.3 and rbc was down 6.1 and I felt like a bus ran over me. My 2nd treatment it was wbc 15.9 k/ul and rbc was 7.62 m/ul. I felt like crap and asked them what all that kul and mul stuff meant. They said it was the way the chemistry is done at the lab. I told them I was no chemist and needed it broken down like it was the first time it was read. I never got a straight answer but they said it was not bad for a person on chemo. Still not satisfied with the answer because I was feeling so tired. They said those numbers on the second reading were actually a little lower if read like the first reading. Confusing as hell to me. Anyway when I get my readings now they are printed out like the 1st reading. At my 5th round the wbc was 10.2 and rbc 3.98. You can see the the rbc did drop along the way, but still high for a person getting chemo. The wbc climbed pretty high due to the shots. I can't imagine what would have happened if I had not gotten that shot each time and had that tooth problem. That would have tore those white counts to hell. Probably would have wound up in the hospital. Its the rbc's that determine your enery levels. I think they can drop down into the high 3's and still feel okay but not 100%. You would be nearing the anemia level at that point. John
I can tell you the shot will cause some pain in the hips due to rapid wbc production.

allmost60's picture
allmost60
Posts: 3163
Joined: Jul 2010

Hi John,
It sure can get confusing, can't it? I didn't have a clue what the kul and mul stuff ment either...ha! I guess I will find out soon enough if a "shot" will be needed or not. My onc appears to be a little bit on the conservative side when giving me any drugs. I think that stems from my sharing how so many meds have the opposite re-action with me than what others experience. I've always gone with the "less is best" approach when taking any medicine. Hope I don't go in on Tuesday expecting to get my 2nd round and for some reason my blood counts could interfere. Think I'll call tomorrow and ask the chemo nurse if my counts looked good from Fridays labs...may help keep my nerves in check Monday evening. Does everyone get a little anxious right before a round? I imagine so. Thanks for taking time to respond John....(my go to guy)..ha!
Sue

COBRA666's picture
COBRA666
Posts: 2418
Joined: May 2010

Sue,
I really doubt your RBC's are low. If they were you would feel tired and worn out. Other counts could be low,like the white cells and you would never know it. All the counts will drop some as treatments go on. It can't help but drop because the chemo does kill the good ones along with the bad ones. As long as they stay above ,I think the number is one you will be able to get the treatment. Of course your A$$ might be dragging if that RBC drops too much. Some people on here can verify that. I know my butt was the last treatment and my counts were not even that low. I like to be outside and walking I was not picking my feet up high enough and actually wore the soles out on my tennis shoes and that is no joke. It was just the chemo beating me up. I believe Mary said she crossed the finish line on her knees. I hope your counts stay up like mine did,but if you need that shot and yyour white count drops to far please insist on that shot. You need those white cells just in case you get sick. The wbc's rise when we get sick anyway. Thats how they know we have an infection when we are not on chemo. If we get sick and there are not enough there to fight infection, then there will be a problem. I am not a Dr. and I don't know how some of them feel, but I think it is just common sense. That may be why some wind up in the hospital. Don't want to do that. John

allmost60's picture
allmost60
Posts: 3163
Joined: Jul 2010

Hi John,
I already discussed the shot with my onc and she said if my counts drop she won't hesitate to give it to me. She will be conservative only to a point, is the impression I get. She certainly knows "NOT" to be conservative the next time a BMB is needed...I made that crystal clear with her...no sedative...no BMB..ha! I have no doubt as the chemo builds up in my system that there will be more A$$ draggin days than what I've experienced thus far. Kind of glad winter is coming. I won't mind staying inside so much on those "down" days. Nice fire going while curled up in my comfy chair doesn't sound all bad. Take care and thanks for the feedback...always so helpful!...Sue

forme's picture
forme
Posts: 1158
Joined: Aug 2010

Hi Sue,
Hope all is well with you. I know that labs can be crazy to read and understand. Maybe I can help a little. Labs use the metric system. In america we use the metric system, but it is different from other parts of the world. Crazy..
White blood cells are measured in thousands per cubic milliliter of blood ( K/uL )
Red blood cells are measured in millions per cubic milliliters ( M/uL )
This is an example of a WBC 4.8K/uL is 4,800 cells
Hope this make it a little easier to understand. If you want to know other meanings, just ask, i"ll do my best to answer.
I still remember something from nursing school...LOL
Lisha

allmost60's picture
allmost60
Posts: 3163
Joined: Jul 2010

Hi Lisha,
All is good with me other than a little pre-treatment jitters creeping into my thoughts every now and then. I have been so happy with how I've felt since my first round but now I'm getting antsy wondering how this next round will be. I need to remember to just "stay in the day" and not get ahead of myself. Hate to even think about the dredded "P"...but promised myself to keep a positive attitude about it since I survived the 5 days I had to take it on round one. How are you doing? Hope all is going ok. Anymore news on your mother-in-law? Hope she will respond well to the treatment she has chosen to go with. Take care Lisha... my prayers are with you and your family.
Love....Sue

merrywinner's picture
merrywinner
Posts: 620
Joined: Aug 2009

They look OK to me. I had R CHOP but I imagine it acts about the same. The blood work takes a hit and then usually rebounds by week three. That's why they have that interval in between. My "window" as they called it, when my counts were the lowest, was days 10 thru 14 and then they would start to go up. This remained my pattern throughout my whole treatment. I was told that patients establish a pattern and it usually continues that way. A word about the Wbcs. as you probably know there are different kinds. My counts were always broken down into numbers of kinds. The ones they are most interested in are the neutrophils. So if you want to know and are interested ask and keep track of those. Mine went fairly low at times but would recover. I worried so much about the blood work but in the end it turned out fine and it will for you too. The fatigue was the hardest but I slept a lot. I can relate to what Cobra said about dragging his feet. I would always joke that I walked like Herman Munster. But it all gets better with time. You will do just fine. Good luck and God bless. Mary

allmost60's picture
allmost60
Posts: 3163
Joined: Jul 2010

Hi Mary,
Thanks for the Neutrophil info. I checked my lab chart and it looks like my N's are lookin OK. The reference range is 40.0-80.0...mine show 68.2 % on Sept 7th lab results. That looks like an "Ok" number to me. I just love the way we learn new things all of the time here! Thanks Mary!!
Love...Sue

merrywinner's picture
merrywinner
Posts: 620
Joined: Aug 2009

That is a great number. You have room to take some hits and still be good to go. I think my all time low was 1.33 or thereabouts. I got a call on that one but just had to be really careful to stay out of the public,wash hands,no sick people in the house etc. They watched closely for it to recover before the next chemo and it did. I never did have the Neulasta(gets it's name from neutrophils). I have no doubt that if needed it would have been given. I think each MD or treatment center has it's protocol. I understand the reasons I did not get it as well as understanding the reasons others are. We are all unique and our treatments will differ accordingly. Stay strong and God bless. Mary

truckingalong
Posts: 444
Joined: Aug 2010

At first treatment, I got similar side effects like yours and took Claritin on 4th day and I felt better.

I too get terrible side effects when I got Neupogen shots - at 2nd treatment, I got 480 micrograms of that shot per day for 8 days because WBC was 2.1 out of the normal range between 4 to 11 and GANT - .4 and other numbers I don't recall at the moment. But headaches and bone pain were unbearable to the point I started getting the beginning stage of migraines that I never had before in my life! Went to neurologist, had tests and was cleared of any pre-existing conditions and I was prescribed a daily regimen of Topiramate 25 mg. (or Topomax). My WBC was then 3.6 and had chemo last Tues. No shots and I am having basically no headaches which is a godsend. However, from now on, my onc said I will need to take Neupogen shots with a lower dosage of 340 micrograms 5 days before each chemo date to keep up my WBC on an even plateau. Well, let's hope I get less bone pain and headaches for that matter. My jaw pain is not too bad so far.... At any rate, yes, it seems that you don't need the shots unless there is a problem!

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